“… Despite the extent of recent policy and practice attention paid to care homes in the UK surprisingly little is known about residents' lived experience (Department of Health, 2009). In part, this reflects the liminal status of people with dementia inside and outside the health and social care system, as well as the genuine complexity of collecting data from people whose cognitive capacity is impaired and whose communications skills are limited (Dening and Milne, 2009). It is notable that an accumulating body of evidence offers valuable insights into the subjective experience of living with early stage dementia in community settings (Milne and Peet, 2008). It is also increasingly accepted that people in the middle to late stages of dementia retain the capacity for emotional expression and many can reliably report aspects of their own experience, such as mood (Phinney, 2008). Research is only now beginning to take account of the perspective of people with dementia and is embarking on the not inconsiderable task of developing approaches and methodologies that can meaningfully capture their voices…”

“… Assessing QoL amongst care home residents is a difficult task; it is a complex construct which is variously measured and evaluated. A number of scales do exist, several of which have been specifically developed for people with dementia such as the QoL in Alzheimer's disease scale (Logsdon et al., 1999; Hoe et al., 2005), the DEMQOL (Smith et al., 2005) and the DQol (Brod et al., 1999). Although instruments vary considerably in nature and content common domains include: physical functioning, cognitive abilities, ability to participate in meaningful activities and mood….”

“… Findings– Research that is attempting to capture the lived experiences of residents further adds to the understanding of quality of life (QoL) and quality of care. Specifically, residents prioritise non-disease-related domains of QoL, which is somewhat different than those identified by relatives, care home staff and “objective” measures….”

“… Originality/value – Not only is it evident that residents are able to describe aspects of their situation but they appear to retain a sense of self and identity. There is a distinctive need for assessment of QoL amongst residents with dementia that places their subjective view of this concept at its core….”

Alisoun Milne is a Reader in Social Gerontology, School of Social Policy, Sociology and Social Research (SSPSSR), University of Kent at Medway, Chatham Maritime, UK and Honorary Research Fellow, Canterbury Christ Church University, Canterbury, UK.

In the invitation to write this article, I am asked to describe my " ...contributions... to cell aging and the telomere story" My research on the phenomenon of cell senescence began more than 50 years ago. From that time until today, the work done on this subject in my laboratory, and that of hundreds of other researchers, can only be described in the allotted space by a few generalizations and even fewer details. From the birth of cell culture technology in 1907, it was believed that all cultured cells, if provided with the proper conditions, would replicate indefinitely.

Fifty-three years later, we overthrew this dogma by finding that, in the best conditions, normal cells have a finite capacity to replicate and that only abnormal or cancer cell populations can replicate indefinitely. We interpreted these findings to impact on our understanding of the aging process. If, as had been thought prior to our work, that normal cultured cells released from in vivo controls can replicate indefinitely, then age changes could not have an intracellular origin.

Our findings demonstrated that, on the contrary, age changes do have an intracellular origin. The hundreds of changes that were subsequently found to precede the loss of replicative capacity have been interpreted to be age changes and the finitude of replication to be an expression of longevity determination.

Age changes are the result of the inexorable dissipation of energy that occurs in complex biomolecules and that, unless repaired, causes their dysfunction. The positive balance of repair and synthetic processes over accumulating dysfunctional substrate molecules shifts after reproductive success to favor the increase in more dysfunctional molecules over repair capability as the repair processes succumb to the same Second Law of thermodynamics.

The processes that control longevity, or how long repair and synthesis processes remain functional and retain their balance over dysfunctional molecules, are governed by the genome. Hence, the information that governs longevity determination is sexually transmitted whereas the aging process is a stochastic or random process governed by the laws of probability that are embodied in the Second Law of thermodynamics.

Epidemiology of multiple chronic conditions: an international perspective

François G. Schellevis

The Netherlands.

“… The epidemiology of multimorbidity, or multiple chronic conditions (MCCs), is one of the research priority areas of the U.S. Department of Health and Human Services (HHS) by its Strategic Framework on MCCs. A conceptual model addressing methodological issues leading to a valid measurement of the prevalence rates of MCCs has been developed and applied in descriptive epidemiological studies. Comparing these results with those from prevalence studies performed earlier and in other countries is hampered by methodological limitations.

Therefore, this paper aims to put the size and patterns of MCCs in the USA, as established within the HHS Strategic Framework on MCCs, in perspective of the fi ndings on the prevalence of MCCs in other countries. General common trends can be observed: increasing prevalence rates with increasing age, and multimorbidity being the rule rather than the exception at old age.

Most frequent combinations of chronic diseases include the most frequently occurring single chronic diseases. New descriptive epidemiological studies will probably not provide new results; therefore, future descriptive studies should focus on the prevalence rates of MCCs in subpopulations, statistical clustering of chronic conditions, and the development of the prevalence rates of MCCs over time. The fi nding of common trends also indicates the necessary transition to a next phase of MCC research, addressing the quality of care of patients with MCCs from an organizational perspective and with respect to the content of care…”

Hi. Just wanted to share with you the best of Europes festivals over the past few months. We have visited most of these in the past and I can assure you that they are great fun. Find time to enjoy life and attend one of these this year. Looking forward to some more interesting posts on the Marina de Bolnuevo blog (http://www.marinedebolnuevo.co.uk). Have a great day.

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Today, I went to the beach with my children. I found a sea shell and gave it to my 4 year old daughter and said "You can hear the ocean if you put this to your ear." She placed the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is entirely off topic but I had to tell someone.